To the six white-coated medical students standing around a
patient's bed at St. Louis University Medical Center, the diagnosis
This 76-year-old man who saw yellow halos around their heads
and smelled poison gas coming from the pictures on the wall had
lost his mind.
But their professor, geriatric psychiatrist George Grossberg,
said no. At the root of the man's hallucinations: a dose of heart
medicine - digitalis - that would have been no problem in a younger
patient but that can produce delirium in the elderly. Lower the
dose, and the man's mind would clear completely.
Such lessons are the reason some doctors say medical schools
need to make training in geriatrics mandatory.
Even though the elderly constitute the most rapidly growing
part of the population, some schools still offer only tidbits
about geriatrics, said Grossberg, head of the geriatric psychiatry
division at St. Louis University.
In 35 years, one in five Americans will be 65 and older. Older
patients often differ physically, psychologically and socially from
younger patients and need special treatment. But in the United
- Only one medical school, Mount Sinai School of Medicine in
New York, has a department of geriatrics.
- Only 11 percent of the 126 medical schools responding to a
survey by the Liaison Committee for Medical Education in 1992
taught geriatrics as a separate required course.
- Only 2.9 percent of medical school graduates in 1992 took an
elective course in geriatrics, according to the American Medical
Locally, St. Louis University requires medical students to
spend four weeks in geriatric training. Neither Washington
University nor the University of Missouri at Columbia requires
training in geriatrics. Both schools weave information about older
patients into required lectures.
Geriatrics is a relatively new discipline. Only in the last
five years have doctors been able to take examinations in
geriatrics through the American Board of Internal Medicine, the
American Board of Family Practice and the American Board of
Psychiatry and Neurology.
Part of the problem is the lack of doctors trained to teach
About 2,000 doctors in the United States are qualified to teach
geriatrics. It would take triple that number to teach geriatrics
adequately in medical schools, and in 1992, no one applied for
more than one-third of the nation's geriatric fellowships,
according to a study by Dr. …